# BUENA VISTA MANOR, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Buena Vista Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740497403
- **Authorized official:** MR. KENNETH D. CARLSON (GENERAL MANAGER)
- **Authorized official phone:** (515) 223-6064

## Contact information

- **Practice address:** 1325 LAKE AVE, STORM LAKE, IA 50588-1907
- **Practice address phone:** (515) 223-6064
- **Practice address fax:** (515) 226-1244
- **Mailing address:** 1325 LAKE AVE, STORM LAKE, IA 50588-1907
- **Mailing address phone:** (515) 233-6064
- **Mailing address fax:** (515) 226-1244

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 0478248 | IA | Yes |

## Other

- **Enumeration date:** 05/16/2007
- **Last updated:** 07/15/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0478248 | — | IA |